RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00675
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060519

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Avionic Technician, medically separated) for “right knee anterior cruciate ligament [ACL] tear status post reconstruction with hamstring autograft” with a disability rating of 0%.

CI CONTENTION:  The CI contends for his unfitting right knee.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060203	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee ACL Tear…	5299-5003	0%	No VA Claim in Record	
Right Knee Medial Meniscus Tear Status Post Partial Medial Meniscectomy with Continued Pain	Cat II		
Right Knee Lateral Meniscus Tear Status Post Partial Lateral Meniscectomy			
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Knee ACL Tear.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in February 2004 for a torn ACL and torn medial and lateral meniscus.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “other tear of cartilage or meniscus of knee, current” for PEB adjudication.  At the time of the PT clinic appointment on 28 April 2005, 13 months prior to separation, the examiner recorded that the CI had no episodes of giving way, no pain and no problems with exercise program.  On examination the ROM was flexion “full” and extension “full.”  There was effusion and the knee was “warm to touch.”  At the time of the sports medicine clinic appointment on 28 June 2005, 11 months prior to separation, there was tenderness on examination.  A Lachman’s test was negative.  Varus/valgus laxity was not present.  On examination the right knee ROM was flexion 140 degrees (normal 140) and extension 0 degrees (normal 0).  At the time of the orthopedic clinic appointment on 10 January 2006, 4 months prior to separation, the examiner recorded that the CI had “chronic medial sided pain and popping” but no locking.  On examination varus/valgus laxity was not present.  A Lachman’s test was negative.  Examination test (McMurray) for ligamentous instability and meniscus pathology was negative.  On examination the right knee ROM was flexion 120 degrees and extension 0 degrees.  The MEB NARSUM, 10 January 2006, 4 months prior to separation, noted that the CI reported pain along the medial aspect of his knee and he complained of “popping.”  He also reported having a sensation of instability with activity.  He had no locking.  He reported intermittent effusions.  The CI had difficulty with running, sports, ladder wells, and stairs.  The MEB physical examination noted an “unsteady” gait, medial joint line tenderness, and trace effusion.  Instability testing was negative except for the Lachman’s test which demonstrated laxity with a solid endpoint.  Examination test (McMurray) meniscus pathology was negative.  On examination the right knee ROM was flexion 125 degrees and extension 0 degrees without painful motion.  The record did not show that the CI attended a VA Compensation and Pension (C&P) evaluation proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously as 5299-5003 (degenerative arthritis).  The Navy PEB also listed “right knee medial meniscus tear status post partial medial meniscectomy with continued pain” and “right knee lateral meniscus tear status post partial lateral meniscectomy” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the “right knee medial meniscus tear status post partial medial meniscectomy with continued pain” and “right knee lateral meniscus tear status post partial lateral meniscectomy” were properly subsumed under the overall rating for the right knee ACL tear IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  There is no record of the VA rating the left knee condition.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, coded 5299-5257.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5257 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee ACL Tear	5299-5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (l) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     j. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     k. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
						   (Manpower & Reserve Affairs)